MRI-guided Laser an Alternative to Epilepsy Surgery

Photonics.comJun 2014
ATLANTA, June 4, 2014 — Many patients suffering from certain types of epilepsy find little relief or control by way of medications. Now there may be a new solution.

A team from Emory University School of Medicine has developed an MRI-guided, minimally invasive laser procedure for patients with mesial temporal lobe epilepsy (MTLE). And they said their study proves that this real-time procedure, called magnetic-resonance-guided stereotactic laser amygdalohippocampectomy (SLAH), is safe and effective.

The study, conducted on 13 adult patients with MTLE whose seizures have not responded to antiepileptic drug treatments, mapped the mesial temporal lobe of the brain, including the amygdalohippocampal complex where MTLE seizures occur.

Researchers distinguished multiple points in the temporal lobe for the MRI-guided laser procedure. The red dot in Fig. A represents the targeted ablation zone.The yellow area in Fig. F represents the total ablated area. Courtesy of Neurosurgery.
With real-time MRI guidance, the researchers were able to determine the exact area of the brain responsible for seizure activity and ablate it with a 15 W diode laser operating at 980 nm.

This was done without the need for open surgery, did not harm any neighboring brain tissue and was successful on all subjects, researchers said. The patients were in the hospital for one day — in contrast to conventional temporal lobe surgery, which typically keeps patients in the hospital for nearly a week and sometimes requires care in the intensive care unit.

The new procedure ablated an average of 60 percent of the amygdalohippocampal complex area, or an average length of 2.5 cm, researchers said. And it effectively reduced or eliminated seizures in all of the MTLE patients. Fourteen months after the SLAH procedure, 10 of the 13 patients reported a reduction in seizure activity; seven of them were free of disabling seizures.

Two patients underwent an additional SLAH procedure, the researchers noted, and one subsequently had to endure standard open surgery.

“Such minimally invasive techniques may be more desirable to patients and result in increased use among the large number of medically intractable epilepsy patients,” said Dr. Robert E. Gross, a professor of neurosurgery, neurology, biomedical engineering and neuroscience at Emory, and director of the Functional, Stereotactic and Epilepsy Surgery Division.

The team is continuing its research with a longer-term study of the SLAH procedure, which includes assessment of the effects on cognitive function.